Validation of ApneaLink Ox™ for the diagnosis of obstructive sleep apnea
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The aim of the study was to validate the automatic and manual analysis of ApneaLink Ox™ (ALOX) in patients with suspected obstructive sleep apnea (OSA).
All patients with suspected OSA had a polysomnography (PSG) and an ALOX performed in the sleep laboratory. For automatic analysis, hypopnea was defined as a decrease in airflow ≥30 % of baseline for at least 10 s plus oxygen desaturation ≥3 or 4 %. While for the manual analysis, hypopnoea was considered when a reduction of airflow ≥30 % of ≥10 s plus oxygen desaturation ≥3 % or increase in cardiac rate ≥5 beats/min were identified or, when only a reduction of airflow ≥50 % was observed. OSA was defined as a respiratory disturbance index (RDI) ≥5. The apnea/hypopnea automatic index (AHI3-a, AHI4-a) and manual index were estimated. Receiver operating characteristics (ROC) analysis and the agreement between ALOX and PSG were performed.
Fifty-five patients were included (38 men; mean age, 48.2; median, RDI 15.1; median BMI, 30 Kg/m2). The automatic analysis of ALOX under-estimated the RDI from PSG, mainly for the criterion of oxygen desaturation ≥4 % (AHI3-a–RDI, −3.6 ± 10.1; AHI4-a–RDI, −6.5 ± 10.9, p < 0.05). The autoscoring from ALOX device showed a better performance when it was set up to identify hypopneas with an oxygen desaturation criterion of ≥3 % than when it was configured with an oxygen desaturation criterion of ≥4 % (area under the receiver operator curves, 0.87 vs. 0.84). Also, the manual analysis was found to be better than the autoscoring set up with an oxygen desaturation of ≥3 % (0.923 vs. 0.87). The manual analysis showed a good interobserver agreement for the classification of patients with or without OSA (k = 0.81).
The AHI obtained automatically from the ApneaLink Ox™ using oxygen desaturation ≥3 % as a criterion of hypopnea had a good performance to diagnose OSA. The manual scoring from ApneaLink Ox™ was better than the automatic scoring to discriminate patients with OSA.
KeywordsPortable sleep monitoring Obstructive sleep apnea Sleep apnea syndromes Diagnosis
The authors wish to thank Ms. Jaquelina Mastantuono for revising the English text.
Disclosure of financial support
Disclosure of any conflicts of interest
Carlos A. Nigro received two ApneaLink Ox devices by the company AirLiquide Argentina to perform this study.
- 5.Caterson ID, Hubbard V, Bray GA, Grunstein R, Hansen BC, Hong Y, Labarthe D, Seidell JC, Smith SC Jr (2004) Prevention Conference VII: obesity, a worldwide epidemic related to heart disease and stroke: Group III: worldwide comorbidities of obesity. Circulation 110:e476–e483PubMedCrossRefGoogle Scholar
- 9.No authors listed (1997) Practice parameters for the indications for polysomnography and related procedures. Polysomnography Task Force, American Sleep Disorders Association Standards of Practice Committee. Sleep 20:406–422Google Scholar
- 19.Gantner D, Ge JY, Li LH, Antic N, Windler S, Wong K, Heeley E, Huang SG, Cui P, Anderson C, Wang JG, McEvoy D (2010) Diagnostic accuracy of a questionnaire and simple home monitoring device in detecting obstructive sleep apnoea in a Chinese population at high cardiovascular risk. Respirology 15:952–960PubMedCrossRefGoogle Scholar
- 22.Rechtschafen A, Kales A (1968) A manual of standarized technology, techniques and scoring system for sleep stages of human subjects. Brain Information Service, Brain Information Institute, University of California, Los AngelesGoogle Scholar
- 23.Atlas Task Force of the ASD (1992) EEG arousals: scoring rules and examples. Sleep 15:174–184Google Scholar
- 24.Consenso Nacional sobre el Síndrome Apneas-Hipopneas del Sueño del Grupo Español de Sueño (2005) Definición y concepto, fisiopatología, clínica y exploración del SAHS. Arch bronconeumol 41 Extraordinario 4:12–29Google Scholar
- 31.Pita Fernández S, Pértega Díaz S (2003) Pruebas diagnósticas. Cad Aten Primaria 10:120–124Google Scholar